Blood Pressure Review

 

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Personal Details

If you have been advised by the surgery to submit your blood pressure readings on a regular basis please use this form.

This uses the default date picker of your device
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May be used to identify you
Health Questions

Smoking Status

Your Height

Your Weight

Please provide a minimum of one day blood pressure readings, up to a maximum of seven days.

Your Blood Pressure Day 1

Day 1 - Measurement

This uses the default date picker of your device
 
   
 
Top Number
Bottom Number
Pulse
Systolic Average (1 Day)
Diastolic Average (1 Day)
 
Your Blood Pressure Day 2

Day 2 - Measurement

This uses the default date picker of your device
 
   
 
Top Number
Bottom Number
Pulse
Systolic Average (Over 2 Days)
Diastolic Average (Over 2 days)
 
Your Blood Pressure Day 3

Day 3 - Measurement

This uses the default date picker of your device
 
   
 
Top Number
Bottom Number
Pulse
Systolic Average (Over 3 Days)
Diastolic Average (Over 3 Days)
 
Your Blood Pressure Day 4

Day 4 - Measurement

This uses the default date picker of your device
 
   
 
Top Number
Bottom Number
Pulse
Systolic Average (Over 4 Days)
Diastolic Average (Over 4 Days)
 
Your Blood Pressure Day 5

Day 5 - Measurement

This uses the default date picker of your device
 
   
 
Top Number
Bottom Number
Pulse
Systolic Average (Over 5 Days)
Diastolic Average (Over 5 Days)
 
Your Blood Pressure Day 6

Day 6 - Measurement

This uses the default date picker of your device
 
   
 
Top Number
Bottom Number
Pulse
Systolic Average (Over 6 Days)
Diastolic Average (Over 6 Days)
 
   
Your Blood Pressure Day 7

Day 7 - Measurement

This uses the default date picker of your device
 
   
 
Top number
Bottom number
Pulse
Systolic Average (Over 7 Days)
Diastolic Average (Over 7 Days)
 

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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